Recurrent hypothermia and hypoglycemia as the initial presentation of hepatitis C

Hepatitis C most commonly manifests with asymptomatic elevations in transaminase levels or in advanced stages, may present with hepatic encephalopathy or ascites. We report the first case in the literature, in which the initial manifestation of hepatitis C induced chronic liver disease was recurrent hypoglycemia and hypothermia. In our case, the hypoglycemia was induced by glycogen depletion from hepatitis C induced chronic liver disease. In chronic liver disease, glycogen stores are depleted from extensive fibrosis and it has been shown that glycogen depletion may herald hepatic encephalopathy, which later manifested in our patient.